HomeMy WebLinkAboutStreet Cut Permit 767 Pleasant Valley Ro APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00 aq�
Name of Firm M Phone No. 860
Address of Firm _��,
Zip Codes
Location of proposed work
Describe fully nature of permit requested_
Starting date v 1 i D Approx.time for completion 8 Ile- - v
Call Before You Dig No. Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST.OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate.North Town of South Windsor
No.cuts
Est.Patch Sizes) sf
d _ — \ /t,-1`t. ✓�`"� Est.Pvt.Thickness in.
C Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$_ fft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
L� ArnL of.Deposft$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.B.Y.D.
AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN OF SOUTH.WINDSOR F Y EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH TH IT AN THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS A OU N- TOW O SO DSOR'S STREET CUT PE IT UAL.
cam:
Sign Y Date: ] G
Title: 1_�l -� �'' Driver's License#•
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF PERMIT
WORK MAY NOT BEGIN UNTIL A PERMIT HAS BEEN ISSUED Y
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08 REV 10-22-08
900112 TOWN OF SOUTH WINDSOR CT
PERMIT NUMBER
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MUNIS APPLICATION# 200900942 °°e�°� �s` A�w,���\ \v wvw�w FEE: 25.00
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APPLICAN �°vwrov� v,o" „v�\\v OCATION
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ADDRESS: 59 MCGUIRE ROAD \� \�uuu \�\ " \` ,ANT VALLEY ROAD
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APPLICANT AGREES TO FURNISH THE TO
THE TOWN OF SOUTH WINDSOR FOR ANY E �F �"; $ � " \ � \ OND REQUIRED AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND THE AP C v "" "'�6�"' °��T
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FOR PERMITS AS OUTLINED IN THE TOWN OF SO I \ \ �' \, `SILL ABIDE BY THE RULES AND REGULATIONS
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ISSUED BY DATE SP CTED INSPECTED BY
8/11/20092:42PM ' PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOa INSPEC ION REPORT
PERMIT NO.: 9 coI l CONTRACTOR: th
ccc, cdocrr4
LOCATION: 1 .0 a 11,0
TYPE OF WORK: b-f
--DATE INSP NEEDED: DATE INSP:
- _ INSPECTED BY:
WORK jN
PROGRESS:
POO
AS-BUILT:
INPUT: C ✓ ' c��'�
DAZE:
W/2007 Town of South Windsor INPSEcnoN REPORT 07